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Imaging in spinal posterior epidural space lesions: A pictorial essay

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ABSTRACT

Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.

No MeSH data available.


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Metastases: Post-contrast axial computed tomography scan images at the level of base tongue (A) and lower dorsal spine in soft tissue (B) and bone windows (C), in a 60-year-old female with previous right hemiglossectomy and nodal dissection, show a large heterogeneously enhancing recurrent mass (star) in the right side of the neck extending from submandibular region to posterior triangle. Note the involvement of sternomastoid muscle and overlying skin of the neck (arrowhead). Erosion of the right lower alveolus is also seen (dashed arrow). Lytic lesion is seen in the left transverse process and costotransverse joint (elbow arrow) with posterior epidural soft tissue (arrow) compressing the cord in lower dorsal vertebra
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Figure 33: Metastases: Post-contrast axial computed tomography scan images at the level of base tongue (A) and lower dorsal spine in soft tissue (B) and bone windows (C), in a 60-year-old female with previous right hemiglossectomy and nodal dissection, show a large heterogeneously enhancing recurrent mass (star) in the right side of the neck extending from submandibular region to posterior triangle. Note the involvement of sternomastoid muscle and overlying skin of the neck (arrowhead). Erosion of the right lower alveolus is also seen (dashed arrow). Lytic lesion is seen in the left transverse process and costotransverse joint (elbow arrow) with posterior epidural soft tissue (arrow) compressing the cord in lower dorsal vertebra

Mentions: Focal bony lesions appear hypointense on T1W and hyperintense on T2W images. Occasionally, rim of T2 hyperintense signal is seen around the lesion, the halo sign. However, sclerotic lesions appear hypointense on all sequences. Diffuse abnormal marrow signal may be observed. Post-contrast T1 fat-saturated images delineate the enhancing metastases as well as associated paraspinal and epidural soft tissue. Epidural soft tissue is commonly associated with the destruction of vertebrae and direct extension throught posterior longitudinal ligamant, or extension through the intervertebral foramina or hematogenous or lymphatic spread. Epidural soft tissue results in the compression of thecal sac and its contents, i.e., spinal cord and nerve roots. Posterior elements, especially the pedicles, may be involved by metastases [Figures 20 and 21].


Imaging in spinal posterior epidural space lesions: A pictorial essay
Metastases: Post-contrast axial computed tomography scan images at the level of base tongue (A) and lower dorsal spine in soft tissue (B) and bone windows (C), in a 60-year-old female with previous right hemiglossectomy and nodal dissection, show a large heterogeneously enhancing recurrent mass (star) in the right side of the neck extending from submandibular region to posterior triangle. Note the involvement of sternomastoid muscle and overlying skin of the neck (arrowhead). Erosion of the right lower alveolus is also seen (dashed arrow). Lytic lesion is seen in the left transverse process and costotransverse joint (elbow arrow) with posterior epidural soft tissue (arrow) compressing the cord in lower dorsal vertebra
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036327&req=5

Figure 33: Metastases: Post-contrast axial computed tomography scan images at the level of base tongue (A) and lower dorsal spine in soft tissue (B) and bone windows (C), in a 60-year-old female with previous right hemiglossectomy and nodal dissection, show a large heterogeneously enhancing recurrent mass (star) in the right side of the neck extending from submandibular region to posterior triangle. Note the involvement of sternomastoid muscle and overlying skin of the neck (arrowhead). Erosion of the right lower alveolus is also seen (dashed arrow). Lytic lesion is seen in the left transverse process and costotransverse joint (elbow arrow) with posterior epidural soft tissue (arrow) compressing the cord in lower dorsal vertebra
Mentions: Focal bony lesions appear hypointense on T1W and hyperintense on T2W images. Occasionally, rim of T2 hyperintense signal is seen around the lesion, the halo sign. However, sclerotic lesions appear hypointense on all sequences. Diffuse abnormal marrow signal may be observed. Post-contrast T1 fat-saturated images delineate the enhancing metastases as well as associated paraspinal and epidural soft tissue. Epidural soft tissue is commonly associated with the destruction of vertebrae and direct extension throught posterior longitudinal ligamant, or extension through the intervertebral foramina or hematogenous or lymphatic spread. Epidural soft tissue results in the compression of thecal sac and its contents, i.e., spinal cord and nerve roots. Posterior elements, especially the pedicles, may be involved by metastases [Figures 20 and 21].

View Article: PubMed Central - PubMed

ABSTRACT

Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.

No MeSH data available.


Related in: MedlinePlus